The effect of small size uterine fibroids on pregnancy outcomes in high-risk pregnancies

Abstract Objective To evaluate the obstetric outcomes of singleton high-risk pregnancies with a small size uterine fibroid. Methods This retrospective cohort study was conducted among 172 high-risk pregnant women who were followed-up by a single surgeon between 2016 and 2019. Pregnant women with preconceptionally diagnosed small size (< 5 cm) single uterine fibroids (n = 25) were compared with pregnant women without uterine fibroids (n = 147) in terms of obstetric outcomes. Results There was no statistically significant difference between the groups in terms of adverse pregnancy outcomes. The size of the fibroids was increased in 60% of the cases, and the growth percentage of the fibroids was 25% during pregnancy. Intrapartum and short-term complication was not observed in women who underwent cesarean myomectomy. Conclusion Small size uterine fibroids seem to have no adverse effect on pregnancy outcomes even in high-risk pregnancies, and cesarean myomectomy may be safelyperformed in properly selected cases.

Embarazo posterior a cirugía conservadora del útero ante hemorragia obstétrica postparto. Presentación de un caso / Pregnancy after conservative surgery of the uterus after postpartum obstetric hemorrhage. Presentation of a case

RESUMEN El embarazo es un proceso natural que debe concebirse sin complicaciones; sin embargo, los desenlaces obstétricos fatales en gestaciones previas, son marcadores importantes de un riesgo incrementado de morbimortalidad materna y perinatal en los próximos embarazos. La hemorragia obstétrica posparto es una de las más frecuentes y severas complicaciones del periparto; como una alternativa terapéutica útil en esos casos, el manejo quirúrgico conservador de útero permite mantener la fertilidad en mujeres con paridad no satisfecha, y mejorar su calidad de vida, aunque en muchas ocasiones, por causas diversas, esto no es posible. Se presenta el caso de una paciente de 26 años de edad, con historia obstétrica de tres embarazos, un parto y un aborto (provocado); y el antecedente de complicación obstétrica hemorrágica en embarazo anterior por atonía uterina, la cual requirió tratamiento quirúrgico conservador con técnicas combinadas (suturas compresivas de Hayman, Ho-Cho y ligadura bilateral de las arterias uterinas). Dos años después, acudió a los servicios obstétricos con gestación de 16 semanas (alto riesgo obstétrico). Este artículo tiene el objetivo de exponer el informe de una paciente en la que se logró la concepción de un embarazo posterior a la realización de cirugía conservadora del útero.

ABSTRACT Pregnancy is a natural process that must be conceived without complications; however, fatal obstetric outcomes in previous pregnancies are important markers of an increased risk of maternal and perinatal morbidity and mortality in future pregnancies. Postpartum obstetric hemorrhage is one of the most frequent and severe complications of the peripartum; As a useful therapeutic alternative in these cases, conservative surgical management of the uterus allows fertility to be maintained in women with unsatisfied parity, and improves their quality of life, although in many cases, for various reasons, this is not possible. The case of a 26-year-old patient is presented, with an obstetric history of three pregnancies, one delivery and one abortion (provoked); and a history of hemorrhagic obstetric complication in previous pregnancy due to uterine atony, which required conservative surgical treatment with combined techniques (Hayman, Ho-Cho compression sutures and bilateral ligation of the uterine arteries). Two years later, she attended obstetric services with a 16-week gestation (high obstetric risk). This article aims to present the report of a patient in whom the conception of a pregnancy was achieved after performing conservative surgery on the uterus.

Intussuscepção uterina em uma cadela sem raça definida - relato de caso / Uterine intussusception in a crossbred female dog - case report

O presente relato descreve uma condição rara de intussuscepção uterina em uma cadela sem raça definida, quatro anos de idade, diagnosticada por meio de celiotomia exploratória e análise anatomopatológica. Foi realizada ovariossalpingo-histerectomia (OSH) como tratamento. Essa patologia geralmente requer manejo cirúrgico porque o diagnóstico inicial pode ser desafiador.(AU)

The present study describes a rare condition of uterine intussusception in a 4 year old crossbred female dog diagnosed by exploratory celiotomy and anatomopathological analysis. As treatment, a ovariohysterectomy (OH) was performed. This pathology usually requires surgical management because the initial diagnosis can be challenging.(AU)

Can the combination of internal iliac temporary occlusion and uterine artery embolization reduce bleeding and the need for intraoperative blood transfusion in cases of invasive placentation?

OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.

Conservative surgical treatment of a case of placenta accreta

Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received

Shock séptico de origen ginecológico por Pasteurella multocida / Septic shock of gynecological origin by Pasteurella multocida

La Pasteurella multocida es una gammaproteobacteria oportunista que produce una zoonosis caracterizada clínicamente por desarrollar cuadros mayoritariamente respiratorios como neumonía y rinitis atrófica, aunque las manifestaciones clínicas pueden derivar de la colonización de tejidos vascularizados y partes blandas de casi cualquier órgano, produciendo hemorragias, dermonecrosis, celulitis, meningitis, abscesos, septicemia, osteomielitis o endocarditis, entre otras. Este microorganismo se transmite a los humanos a través de mordeduras, arañazos o lesiones producidas por animales domésticos (especialmente gatos y perros), pero también salvajes. El diagnóstico es eminentemente clínico, apoyándose también en una anamnesis pormenorizada, y confirmándose mediante el crecimiento bacteriano en medios de cultivo como el agar sangre o el agar chocolate, de las muestras obtenidas de los pacientes afectados por esta rara infección. La antibioterapia con B-lactámicos durante 2 o 3 semanas, es la base terapéutica de este cuadro, aunque existe un alto porcentaje de pacientes con resistencia a los mismos, pudiendo necesitar terapias basadas en otros antibióticos como carbapenem, fluoroquinolonas o tetraciclinas. Las líneas de investigación más actuales están dando una gran importancia a los procedimientos de inmunización en animales domésticos, ya que por una parte son los principales vectores de transmisión y, por otro lado, la vacunación en humanos ha demostrado no ser efectiva, debido a la baja prevalencia de esta enfermedad en las personas expuestas. A continuación, presentamos el caso de una paciente con antecedentes de miomas uterinos y convivencia con gatos domésticos, que sufre un shock séptico por Pasteurella multocida, que tiene como principal foco infeccioso su útero miomatoso.

Pasteurella multocida is an opportunistic gammaproteobacteria which produces a zoonosis characterized clinically by developing majority respiratory pneumonia and atrophic rhinitis, even the clinical manifestations can be derived from the colonization of vascularized tissue and soft tissue of almost any organ, causing bleeding, dermonecrosis, cellulitis, meningitis, abscesses, sepsis, osteomyelitis or endocarditis, among others. This organism is transmitted to humans through bites, scratches or injuries caused by pets (especially cats and dogs), but also animals wild. The diagnosis is clinical, also leaning on a detailed anamnesis, and confirming through the bacterial growth in culture medium such as blood agar or chocolate agar samples from patients affected by this rare infection. With B-lactam antibiotic therapy for 2 or 3 weeks, is therapeutic base, although there is a high percentage of patients with resistance to them, and may need therapies based on other antibiotics as carbapenem, fluoroquinolones or tetracyclines. The lines of research are giving great importance to immunization procedures in domestic animals, since on the one hand are the main vectors of transmission and, on the other hand, vaccination in humans has proven to be not effective, due to the low prevalence of this disease in exposed persons. Then, present the case of a patient with a history of uterine fibroids and coexistence with domestic cats, suffering septic shock by Pasteurella multocida, which has as its main infectious focus your fibroid uterus.

Uterine preservation for advanced pelvic organ prolapse repair: Anatomical results and patient satisfaction

ABSTRACT Objective: The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus. Materials and Methods: This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse < than stage 2. A telephone survey questionnaire was used to evaluate patient's satisfaction. Results: Sixty-six patients with pelvic organ prolapse stage 3, including uterine pro-lapse of at least stage 2 (mean point C at+1.4 (range+8-(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at −6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus. Conclusions: Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse.

Desfecho reprodutivo após septoplastia histeroscópica: estudo retrospectivo / Reproductive outcomes after hysteroscopic septoplasty: a retrospective study

OBJETIVO: Avaliar os resultados reprodutivos após septoplastia histeroscópica. MÉTODOS: Estudo retrospetivo observacional por meio de análise dos registos clínicos de 28 mulheres com antecedentes de infertilidade ou de abortos recorrentes, submetidas à septoplastia histeroscópica. Para a avaliação do desfecho reprodutivo foram consultados os registos informáticos dos Cuidados de Saúde Primários e do nosso Centro Hospitalar, no período compreendido entre a septoplastia e a primeira gravidez ou o presente. Os outcomes primários foram a taxa de gravidez, de recém-nascidos e de abortos após septoplastia. O septo uterino foi diagnosticado por ecografia 2D ou 3D e classificado de acordo com a classificação da American Fertility Society. A septoplastia foi realizada na fase folicular do ciclo menstrual, com recurso da energia monopolar, bipolar e/ou microtesoura. Os programas Microsoft Excel e SPSS versão 17 foram utilizados para comparação do desfecho reprodutivo prévio e posterior à septoplastia. Foi utilizado o teste exato de Fisher, considerando significado estatístico quando p<0,05. RESULTADOS: Foi realizada septoplastia histeroscópica em 20 doentes (72%) com infertilidade secundária e 8 (28%) com infertilidade primária, tendo sido necessária segunda intervenção para remoção completa do septo em 5 casos (18%). Ocorreu um caso perfuração uterina minor. Após septoplastia histeroscópica, 64% das mulheres engravidaram, obtendo-se uma taxa de nados vivos de 48%; gravidez tubária de 4%; e 19% das doentes tiveram abortos espontâneos. CONCLUSÕES: Os resultados do presente estudo estão de acordo com o descrito na literatura, tendo-se obtido uma melhoria significativa dos desfechos reprodutivos, com uma redução da taxa de aborto espontâneo de cinco vezes após a septoplastia histeroscópica. .

PURPOSE: To assess the reproductive outcomes after hysteroscopic septoplasty. METHODS: A retrospective observational study was performed with analysis of the medical records of 28 women with infertility or recurrent abortions undergoing hysteroscopic septoplasty. To evaluate reproductive outcomes we consulted the medical records of our hospital and of primary health care units between septoplasty and the present or first pregnancy. Primary outcomes were pregnancy rate, newborns, and abortions after septoplasty. Uterine septum was diagnosed by 2D or 3D ultrasound and classified according to the American Fertility Society. All procedures were performed in the follicular phase of the menstrual cycle using monopolar or bipolar energy and/or microscissors. To compare the reproductive outcomes before and after septoplasty we used Microsoft Excel and SPSS version 17. Fisher's exact test was considered statistically significant if p<0.05. RESULTS: Hysteroscopic septoplasty was performed in 20 patients (72%) with secondary infertility and in 8 patients (28%) with primary infertility. The septum was incompletely removed during the first hysteroscopy in 5 cases (18%), which required a second surgery. One case was complicated with minor uterine perforation. After hysteroscopic septoplasty, 64% of women became pregnant and 48% live neonates were delivered; 4% of the patients had a tubal pregnancy; and 19% had miscarriages. CONCLUSIONS: The results of this study are consistent with those described in the literature. Patients obtained a significant improvement of reproductive outcomes with a fivefold reduction in miscarriage rate after hysteroscopic septoplasty. .

Laparoscopic Sacral Uteropexy with Cravat Technique--Experience and Results

Objective The aim of the present study was to evaluate the safety and efficacy of a “Cravat’’ technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh. Materials and Methods A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV) who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as ‘very satisfied’, ‘satisfied’ and ‘not satisfied’ at the 6th month postoperatively. Results Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy). Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months. Conclusions Laparoscopic sacral uteropexy with “Cravat technique” was found to be safe and simple procedure. .

Vaginal Removal of Non Prolapsed Uterus with Benign Pathology.

Vaginal hysterectomy was the first minimally invasive surgical approach for benign gynecologic conditions, a number of other approaches for hysterectomy have been introduced, yet when compared with vaginal hysterectomy these approaches do not offer significant benefits for similar indications. Objectives : (1) To know the benign gynecological conditions that can be treated by vaginal hysterectomy. (2) To find out the operative difficulties of vaginal hysterectomy done in non-prolapsed uterus. (3) To know the morbidity and mortality of vaginal hysterectomy. Methodology : This is a prospective study conducted at our Hospital from 1st December 2010 to 30th Nov. 2011. Hundred consecutive cases of non-descent vaginal hysterectomy for benign pathology of uterus were studied. Results : In our study maximum hysterectomies were done in the age group 41-50 (49%) followed by 31- 40 (40%) least were in age more than 50 years. Mean parity of the cases undergoing hysterectomy were 2.47. In 77% patients, complaints were menorrhagia. The maximum hysterectomies, 41% for fibroid uterus were done, followed by 39% for DUB. One patient had intraoperative bladder injury. Mean operating time for the hysterectomies was 53.21 minutes. No mortality was seen, 12% post-operative complications were present. The mean post-operative stay in the hospital was 5.95 days. Conclusion : Vaginal hysterectomy is both feasible and optimal for many patients who long have been considered inappropriate candidates for vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic approach for benign conditions of the uterus.

Reconstrucción anatómica laparoscópica en útero unicorne no comunicante / Laparoscopic approach for unicornuate uterus

Las alteraciones congénitas de los conductos de Müller son un amplio grupo de patología, siendo el útero unicorne una de sus manifestaciones.Se relaciona con un aumento de complicaciones obstétricas y a su vez la presencia de un cuerno rudimentario no comunicante, es causa de dolor pélvico crónico. Presentamos una paciente de 14 años aquejada de intensa dismenorrea. Mediante técnicas de imagen se evidencia la presencia de útero unicorne con cuerno rudimentario derecho no comunicante. Se realizó abordaje laparoscópico en la que se procedió a exéresis del cuerno rudimentario y posterior reconstrucción anatómica. La paciente cursó un postoperatorio sin complicaciones, obteniendo una mejoría clínica satisfactoria en sus controles posteriores. El abordaje laparoscópico a las pacientes afectas de útero unicorne no comunicante permite restablecer de forma óptima la anatomía y mejorar la sintomatología asociada. Mediante una correcta técnica laparoscópica se consigue disminuir el riesgo de adherencias posteriores, asegurando una baja tasa de complicaciones y una recuperación funcional postoperatoria precoz.

Congenital anomalies of the Müllerian ducts are a large group of pathology, and unicornuate uterus is one of its manifestations. It is associated with increased obstetric complications and the presence of cavitated non communicating rudimentary uterine which cause chronic pelvic pain. We report a 14 years old patient suffering severe dysmenorrhea. Using imaging techniques showed the presence of unicornuate uterus with non communicating rudimentary right horn. Laparoscopy was performed in which we proceeded to resection of rudimentary horn and subsequent reconstruction of the anatomy. The patient had an uneventful postoperative course, obtaining a satisfactory clinical improvement in subsequent tests. The laparoscopic approach in patients with advanced non-communicating unicornuate uterus can optimally restore the anatomy and improving associated symptoms. A proper laparoscopic approach can lower the risk of subsequent adhesions, and ensure few complications and early postoperative functional recovery.

Bilharzial endocervical polyp.

Schistosomiasis still represents a major threat to women's health in many developing countries. The frequency in developed countries is increasing among immigrants and tourists who have a history of freshwater exposure in endemic areas. This is a case of 43-year-old immunocompetent Egyptian woman presented by abnormal vaginal bleeding. The gynecological examination revealed an endocervical polyp measuring 3 x 2 x 1 cm. Polypectomy was done. Histopathological examination revealed several granulomas containing viable eggs of Schistosoma hematobium. Schistosomiasis is rarely presented with endocervical polyp. In developing countries, schistosomiasis may be considered in differential diagnosis of patient with endocervical polyp.

La histerectomía obstétrica como terapéutica segura en la morbilidad extremadamente grave / Obstetric hysterectomy as a safe therapy in the extremely severe morbidity

Introducción: la histerectomía obstétrica se define como la extirpación del útero después de un evento obstétrico, opción terapéutica vinculada con estados de morbilidad obstétrica extremadamente grave. Objetivo: determinar características obstétricas y generales en una población de pacientes con morbilidad obstétrica extremadamente grave a las cuales se les realizó histerectomía obstétrica. Métodos: estudio descriptivo de corte transversal, realizado desde enero del 2007 a diciembre del 2009, en el Hospital Ginecobstétrico Mariana Grajales de Santa Clara, Villa Clara. Se revisaron los expedientes de 71 pacientes a quienes se hizo histerectomía obstétrica. Se calculó la incidencia y se identificaron las características clínicas y obstétricas, la relación con el tipo de parto y los principales hallazgos anatomopatológicos asociados a la histerectomía obstétrica. Resultados: se realizó una histerectomía obstétrica cada 463 partos. El promedio de edad de las pacientes fue de 33,8 + 6,78 años. El 78,6 por ciento tenía antecedentes de cesárea. Predominó la histerectomía total abdominal en el 63,3 por ciento de la muestra y en 27 pacientes se realizaron ligaduras de las arterias hipogástricas, 38 por ciento. Se requirió el ingreso en la terapia intensiva en un 69 por ciento de las pacientes histerectomizadas. No se reportaron muertes maternas vinculadas con las histerectomías obstétricas en estos tres años en la provincia. Conclusiones: la histerectomía obstétrica es una opción terapéutica asociada a la morbilidad obstétrica extremadamente grave, donde el accionar oportuno, con dominio técnico y cumpliendo las indicaciones pertinentes se convierte en una herramienta que garantiza la vida de muchas pacientes en momentos críticos

Introduction: the obstetric hysterectomy is defined as the removal of uterus after an obstetric event, therapeutic option linked to stages of extremely severe obstetric morbidity. Objective: to determine the obstetric and general features in a group of patients presenting with an extremely severe obstetric morbidity underwent to obstetric hysterectomy. Methods: a cross-sectional and descriptive study was conducted from January, 2007 to December, 2009 in the Mariana Grajales Gynecology and Obstetrics Hospital of Santa Clara, Villa Clara province. The medical records of l71 patients were reviewed who underwent obstetric hysterectomy. Incidence was estimated identifying the clinical and obstetric features, the relation with the type of labor and the main anatomical-pathological findings associated with obstetric hysterectomy. Results: an obstetric hysterectomy was performed by 463 labors. The mean age of patients was of 33.8 ± 6.78 years. The 78.6 percent had a history of cesarean section. There was predominance of abdominal total hysterectomy in the 63.3 percent of the sample and in 27 patients ligatures of hypogastric arteries were performed (38 percent). It was necessary the admission in intensive therapy service of the 69 percent of hysterectomy patients during this past year in the province. Conclusions: the obstetric hysterectomy is a therapeutic option associated with the extremely severe obstetric morbidity, where a timely action, a technical mastery and fulfilling the pertinent indications, it become a tool to guarantee the life of many patients in critical situations

Is hysterectomy needed in ovarian cancer.

Context: Hysterectomy is an integral part of ovarian cancer surgery. The authors have evaluated the uterine involvement in ovarian cancer in this study. Aims : Conventionally, removal of the uterus is considered an essential part of ovarian cancer surgery, but rationale for same in absence of its gross involvement is questionable. Aim of this study was to evaluate the microscopic involvement of uterus in ovarian cancer and whether there are any predictors of uterine involvement. Settings and Design: Retrospective study. Materials and Methods: The authors analyzed 128 patients of epithelial ovarian cancer (EOC) operated from 2004 January to 2008 June, who had not undergone hysterectomy previously. Data regarding their demographic, clinical, and pathological findings was collected and analyzed. Statistical analysis used: Chi-square test. Results: Most of our patients (n=111) presented with stage III or above. Serous carcinoma was the most common histology encountered (86.7%). Uterus was grossly involved in only 19 patients and microscopic involvement was noted in 20 patients. Only one patient with absence of gross involvement had microscopic disease in the uterus. Involvement of the uterus was found to be independent of stage, type of tumor, laterality, and preoperative chemotherapy. The grade of tumor and gross uterine involvement were only factors that showed statistically significant correlation with microscopic uterine involvement. Only one patient had synchronous endometrial cancer. Conclusions: Uterine involvement in EOC is not common. Absence of gross uterine involvement reliably predicts absence of microscopic disease.

Ligadura vaginal de arterias uterinas en hemorragia postparto: técnica simple, rápida y efectiva / Vaginal ligature of uterine arteries in patients with postpartum hemorrhage

La metrorragia posparto es una de las complicaciones más graves de la obstetricia con importante morbi-mortalidad materna. La ligadura de las arterias uterinas forma parte de la cadena de procedimientos terapéuticos. Esta comunicación muestra una paciente con hemorragia posparto tratada con ligadura vaginal de arterias uterinas, con cese del sangrado y recuperación de la paciente sin complicaciones.

Postpartum hemorrhage is one of the most serious obstetrics complications with significant maternal morbidity and mortality. Uterine arteries ligature is part of the chain of therapeutic procedures. This communication presents a patient with postpartum hemorrhage treated with vaginal uterine arteries ligature with cessation of bleeding after the intervention and recovery without complications.

Patología uterina y su impacto en la fertilidad / Impact of uterine diseases on fertility

El útero es un órgano fundamental dentro del proceso reproductivo y participa en eventos claves, como el transporte espermático, la implantación y la nutrición fetal. Los miomas uterinos, las anomalías congénitas, los pólipos endometriales y las sinequias uterinas son las principales patologías uterinas en mujeres en edad reproductiva, y pueden ser causa de infertilidad, aborto recurrente o parto prematuro. De acuerdo a la evidencia, el tratamiento quirúrgico de miomas uterinos submucosos e intramurales (que distorsionan la cavidad uterina), pólipos endometriales y sinequias se asocia a un aumento significativo en las tasas de embarazo. El tratamiento quirúrgico del septum uterino disminuye significativamente la probabilidad de aborto a repetición y puede incrementar la probabilidad de embarazo en pacientes sin otra causa aparente de infertilidad. El tratamiento quirúrgico de miomas intramurales y subserosos (que no comprometen la cavidad endometrial) es controvertido y su indicación depende de la evaluación de cada caso en particular.

The uterus exerts an important role in the reproductive process and participates in key events, including sperm migration, embryo implantation and fetal nourishment. Uterine myomas, congenital anomalies, endometrial polyps and uterine synechia are the main diseases affecting women in reproductive age, and display a significant impact as asource of infertility, recurrent abortion or preterm labour. According to evidence, surgical treatment of submucous and intramural myomas (associated to uterine cavity distortion), endometrial polyps and uterine adhesions significantly improves pregnancy rates. Surgical treatment of uterine septum significantly decreases recurrent miscarriage rate and can increase odds of pregnancy in patients with no apparent cause of infertility. Surgical treatment in patients with intramural and subserous myomas (without endometrial cavity distortion) is controversial and treatment should be based on an individual basis.

Ganho de peso de novilhas mestiças submetidas ou não à esterilização pela introdução intrauterina de esferas inoxidáveis e ao uso ou não de modificador orgânico / Weight gain of crossbred heifers submitted or not to sterilization by intrauterine stainless globes introduction and submitted or not to organic modifier use

Avaliou-se o ganho de peso de novilhas mestiças, 1/4 Simental e 3/4 Nelore, empregando-se o método experimental de esterilização, que consiste na introdução intrauterina de esferas inoxidáveis. Foram utilizadas 100 novilhas nulíparas, destinadas ao abate, com idades entre 12 e 24 meses e com média de peso de 275kg. Todos os animais receberam o mesmo manejo alimentar, em sistema de pastejo em Brachiaria brizantha, com água e sal mineral ad libitum, e pesagens a intervalos de 28 dias, obedecido o jejum prévio de 16 horas. Os animais foram distribuídos aleatoriamente em quatro grupos (G) experimentais: G1 - composto por 25 novilhas testemunhas; G2 - por 25 novilhas esterilizadas e aplicação de um modificador orgânico; G3 - por 25 novilhas esterilizadas; e G4 - por 25 novilhas não esterilizadas e aplicação de um modificador orgânico. Foram introduzidas 12 esferas de aço inoxidável, previamente esterilizadas, no útero de cada novilha. Houve maior ganho de peso total e diário entre os animais do G2, 140,50kg e 0,578g/dia vs 108,58kg e 0,447g/dia (G1), 103,73kg e 0,427g/dia (G3), 102,68kg e 0,423g/dia (G4), respectivamente. Esta técnica pode ser recomendada aos criadores.

The weight gain in 1/4 Simental and 3/4 Nelore crossbred heifers was evaluated using an experimental method of castration, which consisted of stainless globes intra-uterine introduction. A total of 100 nulliparous heifers, destined to slaughter, aging from 12 to 24-months old and averaging 275kg were used. The animals were randomly distributed in four experimental groups: G1: control; G2: sterilized heifers plus application of organic modifier; G3: sterilized heifers; and G4: non sterilized heifers plus application of organic modifier. It was concluded that G2 showed higher weight gain - 140,50kg and 0,578g/day vs 108,58kg and 0,447g/day (G1), 103,73kg and 0,427g/day (G3), 102,68kg and 0,423g/day (G4). The sterilized heifers plus application of organic modifier is a method of castration recommended to the cattle farmers.

Resección histeroscópica del tabique vaginal en el síndrome de herlyn-werner-wünderlich: reporte de un caso / Hysteroscopic resection of the vaginal septum in herlyn-werner-wünderlich syndrome

El síndrome de Herlyn-Werner-Wünderlich es una malformación uterina caracterizada por útero didelfo, hemivagina ciega total o parcial y agenesia renal ipsilateral. Los hallazgos clínicos son variables; en general se manifiesta después de la menarquia como dismenorrea progresiva, secundaria a la criptomenorrea, menos frecuentemente se asocia a infertilidad. Se presenta un caso clínico y su resolución mediante la resección del tabique vaginal por histeroscopia.

Herlyn-Werner-Wünderlich syndrome is a uterine malformation characterized by uterus didelphys, unilateral blind hemivagina and ipsilateral renal agenesis. Its clinical findings are variable; it generally appears after menarche as progressive dysmenorrhea, secondary to criptomenorrhea, less frecuently it's associated with infertility. We present a case report and its resolution by resection of the vaginal septum trough hysteros-copy.

Septate uterus with cervical duplication and longitudinal vaginal septum: [review] / Útero septado com duplicidade cervical e septo vaginal longitudinal: [revisão]

We present the case of a 19-year-old nulligravida woman with severe dysmenorrhea since menarche; she was found to have a longitudinal vaginal septum, cervical duplication and two endometrial cavities, separated by a complete septum. Diagnosis and management of this unusual Müllerian anomaly are discussed in the context of a literature review.

No presente artigo, relata-se o caso de uma mulher de 19 anos com queixa de dismenorreia intensa desde a menarca. Diagnosticou-se a presença de septo longitudinal vaginal, duplicidade cervical e duas cavidades endometriais, separadas por um septo completo. O diagnóstico e o manejo desta rara malformação Mülleriana são discutidos junto a uma revisão bibliográfica.